Microsoft PowerPoint - Bevezet\351sAng-n\351m2011

Dick Margulis

Description

• cours magistral

PROF. KÁROLY NAGY M.D.,PHD, head Institute of Medical Microbiology Semmelweis University Budapest

• alteration of examination dates
• medical microbiology semmelweis university budapest
• medical microbiology
• virology - bacteriology - mycology - parasitology

Sujets

• Cours magistral
• Microbiology
• Ignace Philippe Semmelweis
• University
• Budapest
• Test (assessment)
• Altération
• Mycology
• Virology

Informations

• Publié par: zoef
• Nombre de lectures: 224

Extrait

BABY‐LED BREASTFEEDING Theneurophysiologicbasisfor infantfeeding

ChristinaM.Smillie,MD,FAAP,IBCLC,FABM Stratford,Connecticut,USA

DeclarationandDisclosure Ihaveanaffiliationwithoneormorepersonsorentitiesthatcouldbe perceivedashavingabearingonmypresentationofthissubject.

Affiliation RoyaltiesfromsaleofeducationalDVDsale GeddesProductions,LosAngeles,USA

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Learning to breastfeed

The problem

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Ready,Aim,RAM Consequences

Baby Tightpainfulgrasp “Suckdysfunction” Breastdistress,shutdown

Mom Senseofincompetence Feelingsofdistressforinfant Prematureweaning Isthereamorephysiologicway?

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THREE Take‐ home messages

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This lecture’s structure

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Observationsin theliterature

Therooting reflexon thefirstday oflife

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1. Babiesarehardwiredtosearch for,findthebreast,andattempt tosuckle. Thisisaninnatecapability,not limitedtothefirst24hoursoflife, thatpersistsformanymonthsand probablyyears. 2. Theabilitytobreastfeedisinnate inbothbabiesandmothersand dependentonundisrupted mother‐babyinteractions. 3. Ourleft‐brainedinstructionsand rulescanimpedethemother’s innateabilitiestointeractwith andlearnfromherinfant. ©2012CMSmillieMD

 Historyofwhatwe’velearned aboutthis.  Briefrompthroughthe neurobiologyofmotherand infantinnatebehaviors,and theinteractionsbetween them.  Videosdemonstratingan alternativeapproach.

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 Odent,1977 Proc.5thInt.Cong, PsychosomaticOb/Gyn,Rome Touch:skin‐on‐skin,caresses Scent,mother’sskinandcolostrum Soundofthemother’svoice  Widström,1987 Acta Pædiatr Scand .  Righard&Alade,1990 theLancet Video:Righard&Frantz,1995&2005

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Baby‐led feeding or baby‐led learning

Message atthetime: Wecan messitup (Videos)

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Hospitalroutinesdisturb Widström,1987 Righard&Alade,1990 Video: Righard&Frantz,1995&2005 However…

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Messagethen BabiescandothisBUT  Limitedtofirst24hours  Andv eryfragile

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Inour practice

1996 observations 5weekoldinfantwithbreastdistress Calmedwithskinonskin,noco‐bathing

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Infant“self‐attachment”

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Video,1998Preemietwin 32weeks 48hrs old Bwt 1580gm

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Video: Righard&Frantz,1995&2005

1990’s terminology

VideoclipsusedwithpermissionofGeddesProductions. FullvideoavailablefromGeddesproduction.com

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HeatherHarris,1994 Melbourne,Australia 1‐montholdinfantwith “breastrefusal” Co‐bathingcalmedinfant— thenabletotakebreast Popularizedas“rebirthing” Misnomer Harrisnevercalledit“rebirthing”

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Co‐bathing

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Observationsinourclinicalpractice Infantswith“breastdistress” Infantswithtightgrasp, motherswithsorenipples Breast&bottlefedinfantswithlearned associationswithartificialnipples (“nippleconfusionpreference”) Prematureinfants Adoption,relactation Prenatalteaching, babieswithnoproblems

1999 Meyer&Anderson CaseWestern Newbornsinfirst3daysinhospital havingtroublelearningtofeed MCNAmJMatern ChildNurs.

Kangaroo carefor full‐terms

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VideoclipsusedwithpermissionofGeddesProductions. FullvideoavailablefromGeddesproduction.com

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Breastfeedingandlactation involve theinteractionofmotherandbaby Asinglebiologicalsystem requiring Twopeople,interacting Communicationbetweenthem Feedbackbetweenthem Physicalproximity&contact

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Maternal infant interaction

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2008 Mothersemi‐reclined Babyinfullbodycontact,semi‐prone Gravityholdsbabyon,freesboth Baby’sinstinctivebehaviors bringout mother’sinstinctivebehavior Instructionsgetintheway ofmother’snaturalinstincts ColsonSD,MeekJH,Hawdon JM. EarlyHumDev2008,84(7):441‐9

VideoclipsusedwithpermissionofGeddesProductions. FullvideoavailablefromGeddesproduction.com

Maternal infant interaction

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Laid‐back approach

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What’s goingon?

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Marshall Klaus

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Learningtobreastfeed: Howdoesthiswork?

Liberated Motor Activity

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Buthowdoesthisinteractionwork? Whatistheneurophysiology?

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The“motherbaby” Asinglepsychoneurobiological system Requiresmore thanneurohumoral interactions Requiresbiobehavioralinteraction

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Neonatologist,UCSF Maternalinfantbonding Infantcompetence Doularesearch:emotionalsupport duringlabor Klaus&Fanaroff, CareoftheHigh‐RiskNeonate Chapteronneurology Primitivereflexes? Rooting,suckling,stepping,others?

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Amiel‐TisonC,GrenierA,NeurologicEvaluation oftheNewbornandtheInfant.NewYorkNY: MassonPublishingUSA,Inc.;1983

ClaudineAmiel‐Tisonand AlbertGrenier Frenchphysiciansconcernedwith newbornneurologicalexam Intrusivenewbornreflexes interferewithgoodexam Proposedtrigger:Unstableneck Forbetterneurologicalexam: Stabilizeneck

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Thekey

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Skin‐on skin Heartto heart

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Infantstate

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Keytoseeinginfantcompetence Whatanymotherknows Observethebabyininteractionwith another Calminfant,alert,communicative state DonaldWinnicott: Thereisnosuchthingasababy; thereisababyandsomeone.

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SteadiesthebabyBOTH emotionallyandphysically Hugeliteratureonkangaroomothercare PretermANDfullterm infants  Thespecialskinonthehumanchest  Infantregulation  Heartrate,respiratoryrate,temperature  Breastfeedingoutcomes  Maternalcompetence  Neurodevelopmentaloutcomes  Brainwiring

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Stateregulation veryimmatureatbirth Babyneedsmothertohelpregulatestate Togetto “quietalert”or“communicative”state…  Touch,stroking,etc helpsinfant regulatestate  Auditory,visualinteractionwith mother Right‐braintoright‐brainconnection  Maternalfeedbackco‐regulatesinfant state—(AllanSchore)

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Two important keys

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Laid‐back breastfeeding (SuzanneColson)

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Necessary conditions

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Keystocompetentinfantbehavior Motherhelpssteadythebaby— keepsthebabycalmandsecure. 1. Emotionally Shecalmsandsteadiesthebaby withhervoice,andherintuitive responsestoherbaby’sbehavior. 2.Physically Shesteadiesthebaby,keepinghis bodyfeelingsnugandsecure.

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ALSOsteadiesthebaby emotionallyandphysically Andnotevenskinonskin! Mothersemi‐reclined (NOTflatonherback) Baby’sfullbodysupportedonmother’s body Allowsbaby GravitytosupportbabyONmother Securityandstabilitytomove Securitytobringoutinstinctive behavior

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…fortheinitiationoffeeding 1. Physicalstability:NEEDSMOTHER Securehipsandshoulders(Glover) 2. Statecontrol—emotionalstability: NEEDSMOTHER Rightbrainedinteractionwithmother (Shore) 3. Internalcues Hungerandthirst(vs satiated) 4. Externalcues Inmother’sarms Olfactorycues Tactilecues: Skinonskinvs.swaddling Visualcues? ©2012CMSmillieMD 24

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Sensory cues for instinctive feeding behaviors

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Newborn instincts

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Bringingout baby’s competence

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Internalfeedingcues Hungerandthirst  Bloodsugardrop(Widström)  Riseinserumosmolality(Marchini) Behaviorsofsatiety mediatedbyCCK  Lipidatendofmeal,freefattyacids Cholecystokin,satiety  Sucklingalone—oxytocin,viathe  vagus yieldsCCKtoo.  Butwithoutlipidmeal,shortlived!

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“Instincts”=Neuroendocrine programsforbehavior Infantbehaviorvarieswith“habitat”— Withmother—  CNSoxytocinrelease,vagalresponse  Relaxedtone,feedingreflexesand behaviors Withseparation—  Sympatheticresponse,elevated cortisol  Increasedtone,stress,“separation distresscry”

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Feedingbehaviorsseen  Bestifintherightplace(onmother) attherighttime(mildhungerorthirst)  Easymother‐babyinteractions  Baby’sbodysnugandsecure  Babycalmandcomfortable  Sensations  thefeelingandsmellofbeingon mother’schest,  thesoundofhervoice  Theinfant’sinstinctiveresponsesthen directthebabytowardthebreast

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Sensory cues for instinctive feeding behaviors

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Externalfeedingcues focusfeedingbehavior Inmother’sarms(Christensson) Olfactorycues(Varendi,Winberg)  Setdirectionofsearch Tactilecues  Chest,cheek,chin,oralmucosa,palate  Promotethecascadeofbehaviors:  Search,step,root,grasp,suckle

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Mothershaveinstinctstoo: Oxytocin’seffect onmaternalbehavior

Mother’s instincts VideoclipsusedwithpermissionofGeddesProductions. FullvideoavailablefromGeddesproduction.com

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Skinonskinvs.swaddling

SkinonSkin 1. Stabilizesbaby 2. Permitsmobility 3. Radiantheatfrommother 4. Perfecttemperatureregulation 5. Mother’sinteractionscalmbaby 6. Stimulatessensationsandresponses tomildhungerandthirst 7. Allowsbabytotouch&feel,explore 8. Undisruptedinfantreflexresponses 9. Easymotherbabyinteractions 10. Allowsbabyfreemovementtofeed

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Swaddling 1. Stabilizesbaby 2. Interfereswithmobility 3. Insulates;doesn’twarm 4. Notemperatureregulation 5. Babyisshutofffrominteraction 6. Bluntssensationsandresponsesto mildhungerorthirst 7. Can’tusehandstotouch,feel,explore 8. Interfereswithinfantreflexresponses 9. Blocksmotherbabyinteractions 10. Interfereswithfeeding,weightgain

SwaddlingstudiesbyBystrova Ketal: Skintemperatureand“thestressofbeingborn”Acta Paediatr 200392:320‐326 NeonatalweightlossEarlyHumDev2007Jan;83(1):29‐39 1/4/2012 ©2012CMSmillieMD 30

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The mammalian feeding sequence

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Howbabies canlearn tofeed

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Babybegins to“search”

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Theneurobehavioralcascade Tactilestimulus Behavior

Chest,abdomen Cheek Chin Oralmucosa Palate

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Search,step,crawl Root Open,reach,grasp Suckle Sustainsuckling

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ONEalternativeapproach First,acalmbaby Wedon’tmakeababylearntofeed Weallowthebabytofollowhisown instinctstolearn Baby,notmother,initiatesfeeding Motherfollowsbaby’slead Seekingcomfortguidesthemother NOPAIN Instinctsstarttheprocessoflearning Successfulmilktransferteachesbaby Movefromaninstinctiveprocess toa learnedprocess

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Patience! Babyleads We’reonbabytime

Baby,notmother, initiatesthefeed

Lotsofwaystogetthere

VideoclipsusedwithpermissionofGeddesProductions. FullvideoavailablefromGeddesproduction.com

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Infantreflexresponses, acascadeofbehaviors— Steppingorcrawling takesinfanttobreast The“searchingresponse” Rooting appearsfarmorecomplexthanjust Newborn turningfacetonipple Suckling reflexesand promotedbystimulusonoralmucosa, palate behavior

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VideoclipsusedwithpermissionofGeddesProductions. FullvideoavailablefromGeddesproduction.com

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Skinonskin,chestonchest Waitforbabytobegin thesearchforbreast “Babytime,”noagenda: timetosocialize Momtalkstoinfant First, Makeseyecontact,communicating, enjoyingeachother acalmbaby VideoclipsusedwithpermissionofGeddesProductions. FullvideoavailablefromGeddesproduction.com

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Mother follows baby’slead

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Babybeginsto“search” Motherfollows

Chintobreast,nosetonipple  Supportneckandshoulders  Facetouchingmom’schest  Nosetonipple  Headfreetomove Allofthesecanbeintuitiveand instinctiveif motherandbabyareleftalone

VideoclipsusedwithpermissionofGeddesProductions. FullvideoavailablefromGeddesproduction.com

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